Nearly 60% of ACA enrollees were uninsured: Kaiser

WASHINGTON (June 23, 2014) — Among Americans who purchased health insurance through the Patient Protection and Affordable Care Act (ACA) exchanges, the percentage of those who were previously uninsured may be twice as high as earlier estimates indicated, according to survey results released today by the Henry J. Kaiser Family Foundation.

Nearly six in 10 people who obtained insurance in the new marketplaces were uninsured just prior to buying coverage, Kaiser reported, with the majority having been uninsured for at least two years. And nearly half of that group had gone without insurance coverage for at least five years.

That’s much higher than the percentage of previously uninsured enrollees reported in previous studies from the RAND Corp. and McKinsey & Co., which had estimated one-third or less of new-marketplace enrollees were previously uninsured.

The latest findings are important because, although the ACA was designed to reduce the large number of uninsured Americans, critics have argued that most people getting healthcare coverage under the law already had insurance. A number of surveys over the last two months have shown that the U.S. uninsured rate has dropped significantly, which is consistent with the Kaiser survey’s findings.

“Most were uninsured because insurance was too expensive, or they didn’t have access to employer coverage,” said Drew Altman, president and CEO of the nonpartisan Kaiser Family Foundation. “The ACA appears to have been a big motivator.”

Income-based premium subsidies have made a significant difference in helping people pay for coverage, said Dean Clancy, a former senior White House health policy official in the George W. Bush administration. “When you give people subsidies, they will take them,” he said. “It’s certainly a way to help get people covered.”

The survey found that those who received subsidies held a more favorable view of the healthcare reform law, and among those who reported receiving subsidies to help them purchase a plan, 60 percent said they benefited from the ACA. But among those who had their coverage canceled within the past year because their plans did not meet Obamacare requirements, nearly 57 percent viewed the ACA in a negative light.

“It’s a mixed bag at best,” Mr. Clancy said. It’s also too early to draw many conclusions from the data, both in terms of the impact on the uninsured rate and public perception.

“There’s too many unknowns with premiums, cost-sharing, employer dumping and skinny networks,” he said. “If I were uninsured, I’d be happy to find coverage. But I might be sad when I realized how costly and skimpy it is. It remains to be seen how happy people will be as they actually use their coverage.”

The Kaiser survey was based on a nationally representative sample of 742 adults who purchased their own coverage. It was conducted in April and early May, so some respondents had little or no experience in using their health plan.

But plan switchers indicated that their new exchange coverage is similar to the coverage they had previously, the survey reported.

The survey also found:

• 34 percent of surveyed enrollees said they benefited from the new healthcare law, while 29 percent said they were adversely affected.

• 55 percent rated their coverage as an excellent or good value, while 39 percent said it was a fair or poor value.

• 43 percent said it is difficult to pay their premiums.

• 46 percent are not confident they could afford their share of the cost of a major illness or injury

The findings suggested that the ACA market for individual coverage “is working far better than critics say it is, but probably not as well as advocates hoped it would be,” Mr. Altman said.

This report appeared in Modern Healthcare, a Chicago-based sister publication of Tire Business.